Objectives: Transmission of HIV infection from the monogamous women to their babies is a problem in India. Prevention of parent to child transmission (PPTCT) program was initiated by National AIDS Control Organization (NACO) to reduce the vertical transmission of HIV.
Aims: This study was conducted to evaluate the outcomes of the babies of the women detected HIV positive in the year 2004 in 10 PPTCT centers of West Bengal.
Methods: The women in antenatal clinics of the PPTCT centers were tested for HIV infection after counseling. During labor, the HIV positive women were given nevirapine and the newborns were given nevirapine as per NACO guidelines. The babies were followed up and tested for HIV infection at 18 months. The results were collected from record books without taking the identity of the women.
Results: The prevalence of HIV infection among the antenatal women was 0.11%. We had the information of the pregnancy outcomes of 49 out of 107 positive women. Of the women who had continuation of pregnancy, 95.34% had vaginal delivery and altogether 88.37% babies were live born. Only 11 babies, out of 38 live born, attended the 18 months follow up and two were detected HIV positive (18.18%).
Conclusion: The protection rate of nevirapine is encouraging. The adherence rate of the subjects must be improved.
Objectives: To compare the efficacy of hyoscine butylbromide with drotaverine hydrochloride for increasing the rate of cervical dilatation in first stage of labor.
Methods: A randomized comparative study was carried out on one hundred women in labor. They were randomly allocated to one of the two groups. Group A included 50 women who were given injection drotaverine hydrochloride and Group B included 50 women who were given injection hyoscine butylbromide intravenously in the first stage of labor. The main outcome measures were the time taken for full dilatation, rate of cervical dilatation, the duration of first and second stages of labor and blood loss in third stage of labor, all calculated separately for nulliparas and multiparas of the two groups.
Results: The two groups were comparable with regards to the gestational age, parity, and average dilatation of cervix at injection of the antispasmodic agents. Average time to full cervical dilatation was significantly less in Group B in both nulliparas (P<0.01) and in multiparas (P<0.05). Similarly, the average rate of cervical dilatation was significantly more in Group B, both in nulliparas (P<0.007) and in multiparas (P<0.02). The same findings were obtained when Bishop’s score was taken as baseline. No significant difference in the side effects of either drug was observed. The difference in the duration of second and third stages of labor and the blood loss were statistically insignificant. Students ‘t’ test was used for statistical analysis.
Conclusion: Hyoscine butylbromide is more efficacious than drotaverine hydrochloride for cervical effacement and dilatation with no increase in the side effects, duration of second and third stages of labor and the third stage blood loss.
Objectives: To determine the causes of perinatal mortality and to find out and adopt measures to reduce perinatal mortality.
Methods: A retrospective study was carried out to analyze the perinatal deaths that occurred over a 3 year period from January 2002 to December 2004.
Results: There were 8474 deliveries and 1208 perinatal deaths during the 3 year period giving a perinatal mortality rate of 142.55 per 1000 births. The still birth rate was 110.69 per 1000 births and neonatal mortality rate was 37.15 per 1000 live births. Low birth weight babies had significantly higher perinatal mortality rate. Antepartum hemorrhage, severe preeclampsia, severe anemia were the most frequent causes of perinatal deaths. Conclusion : Reduction in perinatal mortality could be facilitated by increasing awareness for registration of pregnant women for antenatal care.
Objectives: To study patient characteristics, pre-operative protocols and post-operative outcome in Indian women undergoing tension free vaginal tape (TVT) for urodynamic (stress) incontinence. Methods: Thirty-three women who underwent TVT surgery were evaluated preoperatively for demographic, clinical and urodynamic parameters and postoperatively for voiding dysfunction. They were followed upto 6 months after surgery. Statistical analysis was done using the chi square test.
Results: Voiding dysfunction was seen in eight patients (24.2%), all of whom had short-term dysfunction which resolved with conservative measures. Age, menopausal status, and previous or concomitant pelvic surgery had no influence on the incidence of post-operative voiding dysfunction although previous failed continence surgery was a significant predictive factor (P<0.05). Women who squatted for voiding, had better postoperative voiding function despite having low peak flow rates in preoperative uroflowmetry. It was not possible to conduct satisfactory uroflow studies in many women due to variation in natural voiding positions.
Conclusions: Postoperative voiding function could not be correlated to urodynamic parameters obtained from the conventional urodynamic unit. It is imperative to modify the urodynamic unit to allow women to participate in voiding function studies in their natural voiding position. Prediction of postoperative voiding dysfunction in an ethnic population must be done in confluence with cultural practices.
Objectives : To assess the maternal morbidity during pregnancy, delivery and postpartum period, needing hospitalization and admissions in intensive care unit (ICU), interventions required, and their outcome.
Methods : During the three year period, from 1st July 2002 to 30th June 2005, 55 obstetric patients were admitted to the ICU. Cases were reviewed in detail including age, parity, reason for ICU admission, clinical features, response to interventions and maternal outcome.
Results : Twenty-five antepartum, 27 postpartum, and three postabortal cases made up the total of 55 cases. Mean maternal age was 26.89±8 years, 29% were primigravidas and 71% multigravidas. The length of stay in the hospital ranged from 1 to 15 days. Severe anemia, postcesarean problems, puerperal sepsis, pregnancy induced hypertension, eclampsia, and cortical vein thrombosis were the main reasons for ICU admissions Renal failure, coagulopathy, and respiratory dysfunction were the main organ failures. All women required ventilatory support. Specialized interventions like dialysis, multiple transfusions of blood and blood products, and surgical interventions were also required. 43.63% (24/55) women died, most of them due to multi-organ dysfunction.
Conclusions : Invasive hemodynamic monitoring and ventilatory support were the two main interventions. Improving quality of care before and after admission to ICU may reduce maternal morbidity.
